Mixed Infection withPlasmodium falciparumandPlasmodium ovalein a Returned Traveller: the First Case in Korea

Abstract

Mixed-species malaria infections are often unrecognized or underestimated. We hereby report the first described case of mixed infection with Plasmodium falciparum and Plasmodium ovale malaria in a returned traveller in Korea. In August 2016, a 25-year-old returned traveller from Cameroon and Democratic Republic of Congo presented with fever. He was diagnosed as P. falciparum malaria and successfully treated with artesunate. And 5 weeks after the completion of treatment, he presented with fever and diagnosed as P. ovale infection. P. ovale infection is a rare cause of malaria and often shows delayed presentation due to its dormant liver stage as hypnozoites. At re-presentation, the immunochromatographic test and microscopic examinations of our patient did not reveal P. ovale, which was only detected via polymerase chain reaction (PCR) assay. This case highlights the importance of considering malaria infection even in persons who have previously received malaria treatment. It also shows the usefulness of PCR testing for diagnosing P. ovale infections, which often present with a low level of parasitaemia.

Recent Spatial and Temporal Trends of Malaria in Korea

“…P. ovale occurs mainly in sub-Saharan Africa and islands of the western Pacific [ 22 ], and often presents as mixed infections with other Plasmodium species. The Gyeongsang area has a large population, and thus has major international airports that connect to the West Pacific countries, another favorite destination for Korean travelers.…”

Assessment of Commercial Real-Time PCR Assays for Detection of Malaria Infection in a Non-Endemic Setting

“…On the other hand, a key aspect of a proper malaria diagnosis is the detection of mixed infections. 14 They are frequently unrecognized and diagnosed as single infections, mainly with traditional methods as microscopy and especially when one of the Plasmodium species has a low level of parasitemia, 16 although this can also happen when PCR methods are used. 42 This misdiagnosis of mixed infections may involve inadequate treatment, leading to relapses, 16 damaging the patient's health and the control of the disease in endemic areas.…”

“…14 They are frequently unrecognized and diagnosed as single infections, mainly with traditional methods as microscopy and especially when one of the Plasmodium species has a low level of parasitemia, 16 although this can also happen when PCR methods are used. 42 This misdiagnosis of mixed infections may involve inadequate treatment, leading to relapses, 16 damaging the patient's health and the control of the disease in endemic areas. For this reason, it is important to make a correct diagnosis of mixed infections, and molecular methods are essential.…”

“…infections can lead to severe complications among malaria patients, meaning an important burden of malaria infections that are often unrecognized or underestimated. [14][15][16] Diagnostic procedures identifying mixed infections are crucial for therapeutic decisions and effective patient management. 17 One of the most used molecular method for malaria diagnosis is nested polymerase chain reaction (PCR).…”

A Case of Post-Malaria Neurological Syndrome Presenting With Cortical Tremor

“…A total of 71.3% of patients show false positivity for paraneoplastic antibodies [ 5 ]. This underscores the necessity for careful interpretation of positive antineuronal antibody results [ 4 - 6 ].…”